Provider Demographics
NPI:1366598757
Name:MASCOLO, LINDA LOUISE (CNS,APRN)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LOUISE
Last Name:MASCOLO
Suffix:
Gender:F
Credentials:CNS,APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1047
Mailing Address - Country:US
Mailing Address - Phone:203-736-0681
Mailing Address - Fax:203-736-0681
Practice Address - Street 1:378 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1047
Practice Address - Country:US
Practice Address - Phone:203-736-0681
Practice Address - Fax:203-736-0681
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003252363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner